As a Hong Kong–based endocrinologist, Dr Annette W.K. Tso, sits at the frontline of a city where diabetes touches more families, and at younger ages, than ever before.
Each clinic day shows how powerfully everyday choices around food, movement, sleep and stress can steer people toward complications or toward health. Here, she reflects on the rising tide of type 2 diabetes in Hong Kong, and how thoughtful nutrition, regular activity, restorative sleep, a resilient mindset and smart digital tools can together transform an intimidating diagnosis into a clear, practical framework for living well at every age.
What worries you most about diabetes today and what gives you hope?
Diabetes is a long-term condition where blood sugar levels stay higher than they should. Type 2 diabetes (T2DM) is the most common form. It develops when the body becomes less responsive to insulin, and over time, the pancreas can no longer produce enough to keep up.
What concerns me most is how quickly T2DM is rising. Globally, the number of people affected has climbed from around 200 million in 1990 to about 830 million in 2022. That means roughly one in nine people worldwide are now living with diabetes. We are also seeing it appear earlier in life, with youth onset cases climbing in many regions with millions of adolescents affected.
This matters because high sugar levels can increase the risk of heart attacks, heart failure, stroke, kidney failure, vision loss, nerve pain and even lower limb amputation, often before patients feel anything is wrong.
Many people feel well until symptoms like excessive thirst, frequent urination or unexplained weight loss finally appear, by which time some damage may have already been done.
Yet I also feel hopeful. Governments are investing in screening and education, so we have better tools to detect diabetes earlier and treat it more effectively. Newer medications can lower glucose with less risk of hypoglycaemia and protect the heart and kidneys, while supporting weight loss. Most importantly, we now understand that lifestyle changes at any stage can change the trajectory of disease.
What does diabetes prevention look like in daily life?
T2DM is shaped by both our genes and our lifestyle. Family history, past gestational diabetes, central obesity, a sedentary routine or polycystic ovarian syndrome can all increase risk. But even with genetic predisposition, diabetes usually develops gradually, meaning there is a window when the right lifestyle shifts can significantly lower risk or delay onset.
For many, the journey towards T2DM starts with frequent intake of sugary drinks and refined carbohydrates — white rice, white bread, pastries, sweet snacks — that are low in fibre and high in glycaemic index. These foods are broken down quickly, leading to spikes in blood sugar and insulin surges after meals.
This pattern encourages fat to accumulate around the abdomen. Visceral fat is metabolically active, releasing hormones and inflammatory substances that worsen metabolic health, strain the liver and push the pancreas to work overtime. Eventually, people may notice postmeal sleepiness or strong sugar cravings. By then, prediabetes may already be present. Once the pancreas starts to tire and insulin production falls, blood sugar stays high; this leads to T2DM.
As it is difficult to restore pancreatic function once it declines, prevention is far more powerful than trying to treat it later. In everyday life, prevention means reshaping both your plate and your routine in sustainable ways.
On the plate, start meals with a generous serving of vegetables to add fibre and slow sugar absorption; choose whole or minimally processed grains (brown rice, mixedgrain rice, wholewheat noodles or quinoa) instead of refined ones. Be mindful of portion sizes for carbohydrates and fruit. Pair carbohydrates with healthy proteins (fish, tofu, eggs, lean meat, pulses) and good fats (avocado, nuts, seeds, olive oil); and avoid or minimise sweetened drinks and rapidly absorbed sugars, which can cause sharp glucose spikes.
Movement is the second pillar. Muscle mass supports a healthy metabolism even at rest, while aerobic exercise burns energy and improves how the body uses sugar. Studies show that at least 150 minutes a week of moderateintensity aerobic activity, together with strength training two to three times per week and a higherfibre, lower glycaemic diet, can significantly reduce progression from prediabetes to T2DM.
How do sleep, stress and mental health affect blood sugar?
Sleep, stress and mental health are central to balancing blood sugar. When we are stressed or anxious, our bodies release cortisol and adrenaline. These stress hormones evolved to help us in a crisis: they tell the liver to release more glucose into the bloodstream and make our cells more resistant to insulin so that sugar stays available as fuel.
If we live with chronic stress, ongoing anxiety or persistent sleep deprivation – including poor quality sleep from conditions such as obstructive sleep apnoea – stress hormone levels can stay elevated. This keeps the body in a prolonged “alert” state, increases oxidative stress and worsens insulin resistance. Over time, this can contribute to fatty liver disease, higher blood sugar and increased risk of T2DM.
The encouraging message is that emotional wellbeing is not a luxury, but part of metabolic health. Protecting sleep, seeking support for anxiety or depression, and building stress relief practices such as gentle exercise, mindfulness or time in nature all support healthier glucose patterns and resilience
What advice do you have for those recently diagnosed with diabetes?
A new diagnosis of T2DM can feel daunting, but it is also a chance to reset. I usually encourage people to focus on food, movement and mindset.
First, rethink your daily meals. A practical starting point is removing sweetened beverages like soft drinks, sweetened teas and juices from your routine. Then, build meals around vegetables and protein, with smarter carbohydrate choices. Keep portions moderate and include nutritious fats like avocado, nuts and oily fish.
Second, build movement into your routine. Exercise does not have to mean an hour in the gym every day. While a structured programme that combines strength training and aerobic exercise is ideal, small daily choices matter, especially at the beginning. Climb a few flights of stairs instead of taking the lift. Walk part of your commute. Take a brisk walk after dinner. The key is to discover activities you enjoy and that fit your lifestyle so that movement becomes sustainable and enjoyable.
Third, adopt a balanced mindset. While type 2 diabetes is a serious condition, at the same time, a diagnosis does not mean life is over. With glycaemic control and regular followups, many people live long, active, fulfilling lives. A helpful mindset is a positive one, but not in denial — acknowledging the condition and approaching it proactively, while understanding the potential complications. This supports consistent lifestyle changes and medication adherence, which may prevent longterm damage.
How is diabetes changing in Hong Kong?
We see the same global trends in Hong Kong. The Department of Health’s Population Health Survey 2020–2022 reported that about 8.2 percent of the population has diabetes, rising to over 19 percent among those aged 65 to 84.
By 2030, the whole-population figure is projected to approach 13 percent. Of particular concern is the rise of T2DM in younger people, including those under 20, with cases roughly doubling between 2008 and 2017 compared with the previous decade.
The good news is that Hong Kong has launched proactive initiatives for earlier diagnosis. The Chronic Disease CoCare Pilot Scheme invites people aged 45 and above with no known diabetes or hypertension to undergo health assessments. Within the first year, around 40 percent of participants were found to have previously undiagnosed prediabetes, diabetes or hypertension. This is sobering, but it also shows that screening works: when we look for these conditions, we find them sooner and have the chance to intervene before complications appear.
What does a balanced plate look like in Hong Kong?
In Hong Kong, several everyday habits make glucose control more challenging: frequent meals at fast food chains or cha chaan teng with few vegetables and plenty of refined rice or noodles; sugary drinks like lemon honey tea, malted drinks, bubble tea and soft drinks; sauces and marinades that contain sugar; and deep-fried dishes. Many families also eat their largest meal late at night, when metabolism is slower, so a high-carbohydrate meal can push blood sugar higher for longer. Much-loved foods such as rice congee, char siu buns, cheung fan, sticky rice, sweet fruits and dessert soups also tend to have a higher glycaemic impact. A diabetes-friendly plate can still be delicious and culturally familiar. Instead of relying on sugar, we can lean into herbs, spices, aromatics and savoury condiments.
Rather than giving up everything, it helps to make thoughtful swaps and set gentle boundaries: adding extra vegetables to noodle dishes, choosing unsweetened or low-sugar drinks, sharing desserts, having the largest meal earlier in the evening, and adding movement breaks to the workday. These small shifts add up over time
What new treatments, technologies or research developments are you most excited about?
We are in an exciting era for diabetes care. Newer medications such as SGLT2 inhibitors and GLP1 receptor agonists not only improve glucose control with relatively low risk of hypoglycaemia; they also provide added benefits such as heart and kidney protection and, in the case of GLP1 drugs, meaningful weight loss.
At the same time, research is uncovering the molecular pathways that drive diabetes related damage, opening the door to targeted therapies that can slow or even reverse complications.
Regenerative medicine is another promising frontier. Scientists are exploring ways to regenerate insulin producing beta cells and restore insulin sensitivity in the liver. It is realistic to imagine a future in which diabetes care includes not just managing the condition but potentially modifying or even curing it for some Digital health is also reshaping how we prevent and manage diabetes. Apps help people plan meals, count carbohydrates, track physical activity and structure exercise routines, turning abstract advice into daily actions.
Continuous glucose monitors allow people to see their glucose levels and trends in real time, while closed loop systems can automatically adjust insulin delivery based on current readings. As sensor accuracy improves and algorithms become more sophisticated, these tools will further reduce the burden of diabetes management and help people live well.
What is wellness to you?
For me, wellness is a dynamic state of balance, not perfection. It is the ability to feel well in body, mind and spirit, even while accepting that ageing and illness are part of being human. It means understanding myself, recognising my limitations and choosing to support my health daily.
I believe our mental health deeply influences physical wellbeing. Approaching life with gratitude, finding purpose in simple routines, striving to do my best and noticing the beauty in people and experiences gives me a sense of inner peace. That feeling of wholeness — living with intention, appreciation and hope — is what wellness means to me.